Hypertension
Dr. Anuradha
Consultant Nephrologist
Sunshine Hospitals
Secunderabad
Epidemiology of Hypertension (HTN)
2012: In India, 23.10% men and 22.60% women over 25 years old suffer from
HTN (WHO)
Percent of Population
40 37.5 38.2
30.3
27.0 27.6
30 27.8 25.4 26.4
26.9 24.8
25.6 23.7 25.0
22.9
20
10
0
NH White NH White NH Black NH Black Mexican Mexican
Men Women Men Women American American
Men Women
13.1% in
4.35% in Agra 15.52% in Bombay 10.99% in Jaipur Chandigarh
Rural
Gupta R19 1994 2075 Rajasthan 1982 1166 23.7 16.9
Malhotra P20 1999 1670 Haryana 2559 3.0 5.8b
Discovery of Essential
Hypertension
Historical Timeline of HTN
1835 1970s
Richard Bright Arthur Guyton
Abnormalities in urine production lead to increased SVR, HTN and Hypothesized that kidney controls BP by regulation of ECV
cardiac hypertrophy Pressure Natriuresis
Harry Goldblatt
Induced malignant HTN in dogs by clipping renal arteries
1930s
No salt diet of
Experiments suggest Impaired pressure Yanomamo Indians
Salt restriction used role for salt in HTN natriuresis in protective against
to treat HTN (Allen) (Dahl) HTN(Guyton) HTN (Oliver)
https://doi.org/10.1152/ajpregu.00250.2005
Role of intrarenal mineralocorticoid axis
Activation of mineralocorticoid receptor despite suppressed
Aldosterone levels
Leads to inappropriate sodium retention
Activation of the mineralocorticoid receptor may be secondary to
Rac1
Rac1 is a member of the Rho-guanine triphosphate hydroxylase family
Activates the mineralocorticoid receptor via an aldosterone-independent
mechanism in the Dahl salt-sensitive, but not in the salt-resistant rat.